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Three questions after abortion and one after miscarriage

I had a surgical abortion at 10 weeks in February. Besides the abortion, I have never been to an OB-GYN, but because I am getting married in May, I would like to go soon. Since it is likely that I will move and never go back to this particular OB-GYN, is it necessary that I tell her about my abortion? Will she be able to tell during the examination? I've read that the cervical opening looks more like a slit than a circle after it has been fully dilated, but I doubt I was fully dilated for the procedure. I don't want to lie or be tricky, and I know it is best to tell a doctor everything about your medical history, but since this will likely be a one-time visit with a doctor I know very little about (ex. pro-life or pro-choice), I would really prefer to avoid the topic if at all possible. Thanks!

Heather Corinna replies:

Given when you had your abortion, you're right: you would not have been anything even remotely close to fully dilated. Your provider would have dilated your cervix to some degree, but only as much as is needed for aspiration, which is nothing close to what is needed for childbirth. At 10 weeks, a fetus is only around an inch in size.

Might you have been dilated enough that a provider could tell you were pregnant before? Eh....probably not.

It really is important that we are as honest as we can be with healthcare provider to assure they can actually do their jobs, but I absolutely hear your concerns. Be aware that overall, OB/GYNs are -- I'd say -- more likely to be supportive of all reproductive choices rather than less, since you're dealing with a group of people who are acutely aware of women's reproductive realities, but it's still not an invalid concern. No one wants to deal with judgment in their healthcare, and it's understandable to want to avoid it when you can.

However, I think the best way to avoid that is just to choose good healthcare providers. Ultimately, no patient should ever even know their doctor's personal feelings in this regard unless you ask. I'll be frank and say that any OB/GYN who, whatever their personal feelings, cannot respect their patient's reproductive choices and history, is probably not a good doctor to see in the first place, since that's going to stand in the way of them doing their best for a lot of women.

If you don't have a choice with your OB/GYN, or just are not comfortable putting that you had an abortion on a medical history form, for all intents and purposes, saying you had a miscarriage and then a D&C for it would be an accurate reflection of your physical gynecological history in regard to the abortion without you having to say you willingly terminated a pregnancy.

I know from working at the clinic that even our own clients will occasionally be dishonest about having had procedures done. Now and then, I'll get a client who will list themselves as having less procedures than we know they have had since we have their charts in our hands. In all honestly, we don't need to know how many procedures they have had before, or even if they have had any at all to give them sound reproductive healthcare. Had you had a complication with your procedure, that would be likely pertinent information, but otherwise, since legal abortion procedures are medically simple and don't change your body or your health unless there is a complication, even if you just say nothing at all about this, it's likely to be okay.

Eves asks,

I had an abortion last winter and until now my period has still not coming back to normal way like before my abortion. After my abortion my period comes every other month or sometimes within two months I still don't get my period. Is this normal?

Within one to two months after an abortion, your periods should return to normal. An abortion can't change your regular menstrual cycle in any permanent or long-lasting way as that cycle is controlled by hormonal systems which an abortion can't influence.

Did you have the recommended follow-up visit two or three weeks after your procedure? If you did, and you were well (and not pregnant) at that point, you can rest assured all is well as far as healing from your abortion goes.

At this point, I'd suggest seeing your reproductive healthcare provider regardless. If your periods have become very irregular, you want to make sure something else isn't going on, whether that's being underweight, having become pregnant again, a hormonal issue or something else.

Jen asks,

As disappointed as I am in myself, from the age of 16 to about 20 I have had three medical abortions (never doing it again promise). I'm 22 now, but since the last time sex doesn't feel the same anymore and I was wondering if its because of the abortions. And now more then ever, every time I have sex I get extremely wet.. like too wet where I don't even feel my boyfriend anymore and I hate it. I used to have sex at least once everyday and now I have sex maybe once every two weeks can this be a reason why I get too wet now? Is there any medical surgery that makes your vagina tighter?

A medical abortion -- the abortion pill -- can only be used for very early pregnancies, and passing the small amount of uterine lining (even though I know it can look like a lot) and the incredibly tiny gestational sac, nor the medications used for a medical abortion, are not things which have anything to do with the glands involved with vaginal lubrication or the muscles of the vagina. Effectively, while the bleeding and cramping tends to be heavier for a day, a medical abortion doesn't do anything different to your body that your regular period does.

How much women lubricate is generally about how aroused or relaxed a woman is. It's common for women to have a tougher time getting relaxed and aroused when they're first sexually active than later, so I'm unsurprised to hear you reporting that several years after becoming more sexually active you're finding you're lubricating more. As well, the vagina being less "tight" is usually also about relaxation and arousal. The frequency of the sex you have is something else that isn't going to have any impact here.

And seriously, you don't even want to get me started on cosmetic labial or vaginal surgeries for totally healthy women without an actual genital injury. I wouldn't endorse anyone going that route regardless, but know that there is not yet a surgery which makes the vaginal canal (rather than just the opening) smaller or tighter, and even if there was, it'd not be necessary. The vagina is a muscle, and a strong one. If you feel like the tone of those muscles isn't what it could be, you can work on that with Kegel exercises, when you're not having sex, with masturbation and/or during sex with a partner.

I would be sure you are current with your sexual healthcare. If you are having increased discharges all the time, you want to be sure, for instance, that you don't have them due to an infection like Chlamydia or a bacterial infection. If you get a clean bill of health on that score, you can rest assured that this is all normal. Lubrication is healthy, and so is the vagina loosening with arousal and relaxation, but if you're finding these things change your experience of sex, you may just need to make some changes to the sex that you're having. That may mean adding other activities to your sex life besides intercourse, experimenting with new positions or dynamics during intercourse. It also sounds to me like you might need to just revisit your own sexuality, separate from your partner: how about investing some extra time in your own masturbation?

Additionally, if you feel bad about your procedures -- and it sounds like you do -- or the situations they were brought about by, your feelings may have something to do with how you're feeling about sex. It's not at all atypical for women to be less excited about or satisfied with sex after abortion or childbirth. So much of our sexuality is really about what's going on in our hearts and minds, with reflections of that acutely felt in our bodies. If you feel conflicted about sex, your body or your genitals, that's going to tend to be mirrored in your sexual experiences.

One more thing? You don't have to promise me or anyone else you will never have another abortion.

If you feel that, for yourself, it's just not right for you to have any more, okay. But as far as the rest of us are concerned, it's just not our business. Women know what we need to do, we know when it is and is not right for us to bring a child into the world, and we know what a big decision that is. I trust you to make the choices that are right for you, any pregnancy, and for any children you may or may not birth, and I trust in the choices you have made. I can only presume that, like most women, you decided to abort after thinking about all of your options and thoughtfully and carefully made the best choice you could. That's what's important in making reproductive choices and what makes them good ones: not that a given choice was made or not made, but that whatever choice was the best one you felt you could make for yourself and a child.

In other words, I'm certainly not disappointed in you, and I hope that you can get to a place where you're no longer disappointed in yourself, either.

Amber asks,

I don’t know if this is the appropriate place to ask this question, but so far this is the only place I can find to ask someone for any kind of advice. I can’t see a counselor or anyone because I can’t afford it at the moment. Anyway…on with my concern. I’m 18yrs old and recently had a miscarriage in April, three days before my 18th birthday. I was traumatized by the whole event. He (I refer to the fetus as he as I was hoping for a boy) was my miracle baby because my fiancé was told he is infertile. And ever since then I can’t become sexually aroused, and if I do manage to do so, sex is painful. Emotionally and physically. I’ve been to the ob/gyn and they say I’m fine. Could my physical pain be a manifestation of my psychological state? My fiancé is an extremely sexual person and I was just wondering is there anything I can do? I fear this might ruin my 2 year relationship and I’m terribly afraid he will call off our upcoming wedding. (10/31/08) Please help if you can…I would understand if you can’t. Thank you so much for taking the time to give me whatever help you can. You have no idea how much I will appreciate it.

Given you've got a clear bill of health from your gynecologist, and because sexual arousal is primarily psychological, I'm inclined to feel like these issues are probably more emotional or psychological than anything else.

Miscarriage is something that is thought to occur with as many as 50% of all pregnancies, but while it's very common, that doesn't mean it's easy to deal with. When a pregnancy is wanted and either terminates itself or has to be terminated, it is often a substantial loss for many women. It obviously has been one for you, and I'm so sorry for your loss.

What really strikes me in all this, however, is that you seem to feel very pressured to meet your partner's sexual desires, to the point that you are concerned he will call off your wedding if you do not. That, in and of itself, could very easily be part or even all of why you're feeling the way you are. It's pretty tough to get excited about sex if it feels like a requirement, rather than an obligation. And the more pressure we tend to be put under -- or put on ourselves - the harder it can get to feel aroused. There's really just very little to find sexy about feeling like we have to put out or else we lose someone.

A relationship -- even when it is one which is sexual is part -- is a lot bigger than sex. Making a life with someone is bigger than sex. When we are in a relationship over time, there are usually going to be times, for any number of reasons, when one or both partners just aren't feeling it when it comes to sex for a while. No matter what level of libido we have, it isn't sound to ever expect a partner to meet our every sexual desire, or to expect there won't be times when it's best for us to just use our own two hands to satisfy ourselves.

Certainly, the loss of an unexpected but wanted pregnancy would be the kind of thing that I'd completely expect to cause sex to be on hold for a while. It's pretty darn hard to compartmentalize our sexuality and our reproduction, so when we're grieving over something reproductive, it's typical for that to impact our sexuality and desire for sex. And by all means, a reproductive trauma can become a sexual trauma: in other words, we can feel traumatized by sex when it resulted in a different trauma, even when it wasn't sexual in and of itself.

I'd strongly suggest you sit down and talk to your partner about all of this. Talk about your continued feelings of loss with the miscarriage, and ask for the support you need. It's totally okay if you still need a lot of it, so long as you can understand that your partner may not be able to provide all you need: it's probably a good idea to supplement his support with help from a counselor or support group at this point.

Talk about your worries with your lack of libido and what that could mean in terms or your relationship and impending marriage: just opening that door may well make you feel a lot better in and of itself. get his assurance -- and seriously, if he loves you, he should give it to you -- that he's okay holding off on sex while you work through this. Heck, I'd be more concerned about making a lifelong commitment to someone who couldn't set sex aside so you can work through something like this than I would about him calling things off. You want to be sure you're making that commitment to someone who can make the same level of commitment to you, after all.

When it comes to getting back in the groove of things sexually, it might help to take baby steps. In other words, rather than trying to go right back into intercourse, how about spending some time with a lot of cuddling, with things like shared baths, massage or mutual masturbation, with oral or manual sex for you both? How about making an agreement that you can both explore some of these things when you do feel some desire with the understanding that you get to stop at any time, and that there's no need for any of it to have to result in orgasm? And by all means, if it hurts -- be that emotionally or physically -- just don't do it. The physical pain you're experiencing is something I'd also talk more to your gynecologist about: you'll want to see what he or she suggests you do when it comes to that: it may be that you need some physical treatment before going back to intercourse or other vaginal sex.

I know you're probably getting into the throes of planning for your upcoming wedding. That can be terribly stressful, and that stress is not likely to help you out. So, please ask for all the help you need, delegate as you can, and if you're having a really hard time right now, I hope you feel able to push your date back if you need to, or treat yourself to a weekend away with friends or by yourself to get a respite. If you haven't done anything to give yourself some real closure with this -- some of women who miscarry do find that some kind of service or ritual is helpful for them -- do what you need to for yourself.

Lastly, I don't know what the context of your partner being told he was infertile was, but I would find out more about it. It may be that you should be prepared to have miscarriages if you become pregnant from here on out if it's a matter of something being wrong with his sperm -- and you should know that, and obviously if that's the case, find a good method of birth control so you don't have to keep going through this. It may be that he is not, in fact, infertile at all, which you should also know, for obvious reasons.

Regardless of whether he is or is not fertile, please also know that if you want to have a child in the future, you have options, whether we're talking about sperm donation, IVF, surrogacy or you two having a pregnancy the way you already have or about foster care or adoption. Trite as it might sound, miracles happen all kinds of different ways, and there are many ways to have a family, and this doesn't have to be an ending for you.

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